NEBDN Dental Radiography Registration Form

Course

Title

First Name (as it appears on your passport)

Last Name (as it appears on your passport)

GDC Number

Email Address

Phone Number

WhatsApp number (If you don't have one, you must download it)

Date of Birth

Full Address including Post Code

Nationality

Are you currently working as a Dental Nurse?

Name of the Clinic, Address, Contact Email and Contact Phone Number

Part Time or Full Time

Education (Name of School/College/University)

Work Experience

Are you allowed to live and work in the UK?

How did you hear about us?

Declaration Declaration I accept to pay monthly course fees every month, 150 per month, regardless of if I am currently working or not. I understand that my course ends in September 2024 (meaning if for any reason you want to extend the course, then the monthly fee of £100 per month will be applied as well as any exam deferral or re-sit fees or any other NEBDN admin fees. (This includes not being prepared for exam, failing the exam, requesting to take the exam later)). I understand that if I don't pay monthly fees every month, my course will be discontinued. I understand that any fees paid to Dental Tutors are non-refundable. I declare that I have completed this application truthfully and to the best of my ability. I understand that cheating during the exams will not be tolerated and students will experience severe consequences if found cheating. More information about this is available on the students hub and our website.